Ren Shuyue, Huang Yajue, Shah Pallav, Manucha Varsha
Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, Pa. 19140, USA.
Acta Cytol. 2012;56(2):209-13. doi: 10.1159/000332377. Epub 2012 Feb 17.
Squamous cell carcinoma metastatic to cerebrospinal fluid (CSF) is a rare diagnosis on cytology, and thereby more challenging in comparison to an adenocarcinoma metastatic to CSF. We recently encountered a case of metastatic squamous cell carcinoma in CSF. The primary site was unknown. A review of the literature was performed to understand why this is a rare diagnosis in cytology.
A 56-year-old male was diagnosed with a keratinizing squamous cell carcinoma involving multiple lymph nodes in the neck. On extensive clinical and radiologic evaluation, a primary could not be identified. Subsequently, the patient presented with sudden loss of vision (in the right eye), nausea and vomiting. MRIs of the lumbar spine and optic nerve were suggestive of leptomeningeal and perineural seeding, respectively. Cytologic evaluation of CSF revealed a few atypical, round hyperchromatic cells which were confirmed as epithelial cells through immunocytochemistry for a broad-spectrum keratin. The diagnosis of metastatic carcinoma consistent with squamous cell carcinoma was rendered.
Definitive diagnosis of metastatic squamous cell carcinoma is challenging unless clinical evidence is present. Besides other factors, the mode of spread to CSF may be responsible for this less common diagnosis.
转移至脑脊液（CSF）的鳞状细胞癌在细胞学检查中是一种罕见的诊断，因此与转移至CSF的腺癌相比更具挑战性。我们最近遇到了一例CSF转移性鳞状细胞癌病例。原发部位不明。进行了文献回顾以了解为何这在细胞学检查中是一种罕见的诊断。
一名56岁男性被诊断为角化性鳞状细胞癌，累及颈部多个淋巴结。经过广泛的临床和影像学评估，未发现原发灶。随后，患者出现突然失明（右眼）、恶心和呕吐。腰椎和视神经的磁共振成像分别提示软脑膜和神经周围播散。CSF的细胞学评估发现了一些非典型的圆形深染细胞，通过广谱角蛋白免疫细胞化学证实为上皮细胞。做出了与鳞状细胞癌一致的转移性癌的诊断。
除非有临床证据，否则转移性鳞状细胞癌的明确诊断具有挑战性。除其他因素外，转移至CSF的方式可能是导致这种较少见诊断的原因。
